Treatment of locally advanced non-small cell lung cancer with combination of chemotherapy and radiation

The treatment of locally advanced non-small cell lung cancer has improved substantially over the past 20 years. Almost three times as many patients are able to achieve long-term survival today compared with the mid-1980s. This improvement has been possible through the cooperation of physicians from different specialties involved in the care of lung cancer patients. More accurate staging, with the use of positron emission tomography, led to more accurate stage classification. Patients with detectable systemic disease can be spared from an aggressive local therapy whereas patients with small volume, stage IIIB, can receive the most appropriate treatment. Clinical trials in the United States and around the world have identified the role of each treatment modality and the appropriate timing of administration. The present standard of care is the concurrent administration of cisplatin-based chemotherapy and radiotherapy. This is a treatment that can be associated with significant morbidity, and patient selection is paramount. Chronological age, by itself, should not be a reason to deny a patient the most appropriate treatment for lung cancer. The presence of comorbidities, on the other hand, is a key factor in deciding the most appropriate treatment. When the concurrent administration of chemo- and radiotherapy is not appropriate, the sequential delivery of these two modalities is superior to each of them given alone. Over the last 6 months, two trials have shown that erlotinib (an epidermal growth factor receptor inhibitor) and bevacizumab (a vascular endothelial growth factor inhibitor) improve survival in non-small cell lung cancer patients. These findings represent a landmark in the care of lung cancer patients. We are entering an era of improved patient identification and more logical therapeutic approaches. The incorporation of these "targeted therapies" in the treatment of patients with locally advanced disease is being actively investigated and will, it is hoped, translate into significant therapeutic benefits for the patients.